Need help choosing the right code?
Ask CasePilot about procedures, modifiers, bundling, and coding guidance.
Try CasePilot| Short Descr | Home vent non-invasive inter | Coverage | Special coverage instructions apply | Pricing Indicator(s) | 31 – Supplies And Surgical Dressings - Frequently serviced DME (price subject to floors and ceilings) | MPI | A – Not applicable, as HCPCS priced under one methodology | MCM | 60-9 | Processing Note | PUBLICATION 100-03, CHAPTER 1, SECTION 280.1 (100.03, 1, 280.1). | BETOS | D1E – Other DME | TOS Code(s) | R – Rental of DME | Added Date | 1/1/2016 | APC Status Indicator | Non-Implantable Durable Medical Equipment | MUE | 0 | MUE | 2 | IOM | 100-03, 4, 280.1 | OTS Orthotic | No |
| RR | Rental (use the 'rr' modifier when dme is to be rented) | CR | Catastrophe/disaster related | KX | Requirements specified in the medical policy have been met | GW | Service not related to the hospice patient's terminal condition | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | GZ | Item or service expected to be denied as not reasonable and necessary | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | KR | Rental item, billing for partial month | N1 | Group 1 oxygen coverage criteria met | TW | Back-up equipment | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | GE | This service has been performed by a resident without the presence of a teaching physician under the primary care exception | GL | Medically unnecessary upgrade provided instead of non-upgraded item, no charge, no advance beneficiary notice (abn) | KH | Dmepos item, initial claim, purchase or first month rental | KI | Dmepos item, second or third month rental | KJ | Dmepos item, parenteral enteral nutrition (pen) pump or capped rental, months four to fifteen | KT | Beneficiary resides in a competitive bidding area and travels outside that competitive bidding area and receives a competitive bid item | KZ | New coverage not implemented by managed care | N2 | Group 2 oxygen coverage criteria met | RA | Replacement of a dme, orthotic or prosthetic item | U3 | Medicaid level of care 3, as defined by each state |
|
Date
|
Action
|
Notes
|
|---|---|---|
| 2016-01-01 | Added | Added |
Get instant expert-level medical coding assistance.